Amid Delta Surge, Should Schools Mandate Masks And Vaccines? : Consider This from NPR In the next few weeks, millions of children will head back to school. Many of them are too young to be vaccinated. At the same time, children are being hospitalized with COVID-19 in small but growing numbers — and approaching rates higher than the winter surge.

Dr. Marcos Mestre with Niklaus Children's Foundation Hospital in Miami told NPR's Weekend Edition Sunday many of the children his hospital is treating come from families with unvaccinated parents or caretakers.

Unlike last year, many schools will have no remote learning option this fall. While some may have mask mandates, a handful of Republican governors — including Florida's Ron DeSantis — have issued executive orders banning those mandates. NPR's Pien Huang surveyed experts about how to keep children safe during the delta surge. Read more coverage from the NPR science desk here.

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Uncharted Territory: Back To School Meets The Delta Surge

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UNIDENTIFIED PERSON #1: I pledge allegiance to the flag of the United States of America.


Over the next few weeks, millions of kids will be going back to school in person, and many of them are too young to be vaccinated.


UNIDENTIFIED PERSON #1: Welcome to this special meeting of the school board.

CORNISH: Which means a lot of parents and caretakers...


UNIDENTIFIED PERSON #3: This is particularly scary to me.

CORNISH: ...Feel like they are in a no-win situation.


UNIDENTIFIED PERSON #3: The delta variant is not sparing our children.

UNIDENTIFIED PERSON #4: These kids will get sick. They will bring this home to their families.

UNIDENTIFIED PERSON #5: I never thought we'd live in such a bizarro world where I'd have to come here and plead with the school officials responsible for my children's health and safety.

CORNISH: Now, this could be any number of school board meetings around the country in the last few months. It's from this week in Manatee County near Tampa. Just one day before kids went back to school, the board was hearing from parents as it debated whether to implement a mask mandate.


UNIDENTIFIED PERSON #6: If you're scared, stay home. We have options.

CORNISH: Not everyone supported the idea.


UNIDENTIFIED PERSON #7: My right to choose what is best for the health and well-being of my children is granted to me by God and not the government.

UNIDENTIFIED PERSON #8: What about my kid's choice to come to school in a safe environment?

UNIDENTIFIED PERSON #9: Ignorance is the thought that we have the ability to stop a virus.

UNIDENTIFIED PERSON #10: We are watching Florida burn.

UNIDENTIFIED PERSON #11: Just make it optional. It's not - it's no different.

CORNISH: In the end, the school board voted to keep masking voluntary. And that happens to be as far as Florida's Republican governor says they can go.


RON DESANTIS: Well, I can tell you, in Florida, the parents are going to be the ones in charge of that decision.

CORNISH: Ron DeSantis, along with the governors and a handful of other states, have banned mask mandates in schools, though some districts have defied those bans. Lawsuits and threats of lawsuits are flying back and forth. Meanwhile, COVID hospitalizations in Florida are at record highs, even worse than last winter. And while children face a far lower risk of getting sick, for one of those parents in Manatee County, sending her son back to school with only a voluntary mask policy was a call she didn't want to make.


UNIDENTIFIED PERSON #12: I would estimate that at best, on back to school night, I saw 5% to 10% of people in the entire school wearing a mask. You've left me with an impossible choice - my son's health or his education.

CORNISH: CONSIDER THIS - kids back in classrooms during the delta surge means the pandemic is about to enter uncharted territory. Some parents and public health experts are worried. We'll explain why. Plus, we'll have some advice from those experts. From NPR, I'm Audie Cornish. It's Wednesday, August 11.


CORNISH: It's CONSIDER THIS FROM NPR. Masks aren't the only debate of the new school year. There's also the question of whether vaccines should be mandatory for teachers. On Wednesday, California became the first state to say yes.


GAVIN NEWSOM: All of our staff - not just teachers - credentialed staff, educators, custodial staff, the bus drivers...

CORNISH: Governor Gavin Newsom said this fall, all K-12 teachers and staff must be vaccinated. So will more states follow?


ANTHONY FAUCI: Yeah, I'm going to upset some people on this, but I think we should. I mean, we are in a critical situation now.

CORNISH: That's the president's chief medical adviser, Dr. Anthony Fauci, this week on MSNBC's "Morning Joe." Two of the nation's largest teacher's unions have signaled that they aren't opposed to vaccine mandates, though they also say the vast majority of teachers are already vaccinated. Fauci predicted teacher mandates may get more traction soon if the FDA grants full approval to coronavirus vaccines, which he expects will happen this month or early next. Remember, right now, they're still just authorized for emergency use.


FAUCI: You're not going to get mandates centrally from the federal government. But when you're talking about local mandates, mandates for schools, for teachers, for universities, for colleges, I'm sorry, I think we're in such a serious situation now that, under certain circumstances, mandates should be done.

CORNISH: In plenty of private schools and colleges, mandates are already being done. Nearly 700 college campuses will have vaccine requirements this fall. That's according to a count by the Chronicle of Higher Education. Many have classroom mask mandates as well. But the battleground over mandates right now is in public schools, especially those with children too young to be vaccinated. The best way to protect those kids, Anthony Fauci said, aside from vaccinating the adults around them - well, it's masks, which the CDC recommends indoors in school for everyone.


FAUCI: We know how that can be uncomfortable, but you'd rather have a somewhat uncomfortable situation with a well child than temporarily comfortable and a child in an ICU.

CORNISH: And children in small but growing numbers are winding up in the hospital with COVID. While most children who get sick with COVID-19 have mild symptoms, right now, an average of 229 children a day nationwide are being admitted to hospitals with a disease, and that's up nearly 30% over the previous seven-day average. Child hospitalizations from COVID have been this high just once before - back in January - and they're trending higher even with more than half the U.S. population fully vaccinated.

MARCOS MESTRE: So we've definitely seen an increase in visits to our emergency departments and our urgent care centers. Secondary to that, we've seen increased hospitalizations due to COVID-19 infections.

CORNISH: Dr. Marcos Mestre is chief medical officer of Nicklaus Children's Hospital in Miami, where he told NPR that children with COVID-19 appear to be a little sicker than they were before the Delta surge. He spoke to NPR's Lulu Garcia-Navarro.

LULU GARCIA-NAVARRO, BYLINE: Why are kids getting more sick this time around? Is it something specific to the delta variant? Do we know?

MESTRE: Yeah, we're not exactly sure. And in terms of the severity, we're still trying to determine. It does seem that the children are a little bit sicker, requiring more oxygen and perhaps needing more respiratory support than we were initially.

GARCIA-NAVARRO: And what about the ages? I mean, when you say obviously these are children, what ages are we seeing coming in?

MESTRE: So we've seen the gamut. We see folks from 2 weeks old. Typically, they present with just fevers. Now, those that seem to have the greatest complications are those that are adolescents and especially those adolescents who are overweight or increased BMIs.

GARCIA-NAVARRO: Dr. Mestre, can you take me into the wards? I mean, this must be enormously distressing to see young kids now coming down with this in this fourth wave.

MESTRE: Most definitely, and not only for the families, but also for our staff. Imagine having gone through this. We were getting ready to come out of this in early June. We were even having discussions about peeling back some of the restrictions that we had, and then we were hit with this delta wave. It's well known that there's a nursing staff shortage across the country, and we're no exception to that. And in addition, you're 100% right in regards to the families that are being affected by this. But again, 99% of them are not going to require hospitalization, but that 1% will.

GARCIA-NAVARRO: Dr. Mestre, do we know how these kids got infected? I mean, are they in families with vaccinated parents or caregivers, or are they in families with unvaccinated parents and caregivers?

MESTRE: So it's a mix. Definitely those children that have come in that are older - 12 and older - that would have qualified for the vaccine - none of our patients had received the vaccine. So even though they could have had the vaccine, they didn't. And for those that are younger than 12 years of age, yes, we do see plenty of times that the parents may have not been vaccinated. So that's going to be the most common place where you're going to get infected, is in the home. So what we recommend for those 12 and under is that those parents and those siblings that are 12 and over to also be vaccinated in the home.

CORNISH: Dr. Marcos Mestre with Nicklaus Children's Hospital. That's in Miami.

For some parents and caretakers, the decision to get vaccinated and to protect their young kids may be an easy one. Soon, it might be easy for kids under 12 to get a shot, too. But what won't be easy in the meantime is navigating another fall of temporary shutdowns and remote learning. Plus, in many places, unlike last year, there will be no remote option at all. So given all that, NPR's Pien Huang has been surveying some experts about how to keep kids safe during back to school and the delta surge. Pien is a health reporter on NPR's Science Desk, and she's here now. Hey there, Pien.

PIEN HUANG, BYLINE: Hey, Audie. Thanks for having me.

CORNISH: Masks or not, no matter how many little gold arrows and footprints you paint on the hallway floors, we know that germs spread when young children get together. So what do people think is the right approach if a child does wake up, say, with the sniffles?

HUANG: Well, Seema Lakdawala - she's a flu researcher at the University of Pittsburgh, and she went through this recently. Her 8-year-old woke up sneezing with a runny nose. Step one, she said, was to keep her home. And step two...

SEEMA LAKDAWALA: I will call the pediatrician and just talk through where we've been. If we were traveling, I think I would be more concerned. If we'd been on a plane recently, then I would, you know, definitely want to try to go get her tested.

HUANG: In this case, she and the doctor thought that it was allergies. And sure enough, the kid took some allergy meds and she stopped sneezing.

CORNISH: What would prompt a doctor to say, yes, it's time to get your child tested?

HUANG: It could be a number of things. It could be the symptoms. If your child has a fever or loss of taste or smell, it might be the situation if your kid is exposed, and if there's just a lot of virus transmission going on in the community, they may say, let's just test for it. And experts say it helps to do some research now to know where you can get that test with a fast turnaround time. But another option is to keep some antigen tests at home. You can now get these 15-minute rapid tests from many pharmacies, and they generally cost about $25 for a box of two. But they're considered fairly reliable for people with symptoms. So if someone has the sniffles, it could give you a pretty good read.

CORNISH: All right. What if your child tests positive? I mean, what should a parent be thinking about? What's their first move?

HUANG: Well, for starters, don't panic. Dr. Cassandra Pierre - she's an epidemiologist at Boston Medical Center, and she has young twins. She says that kids are very resilient.

CASSANDRA PIERRE: Yes, with delta variant, we are hearing about more cases of infections, significant infection in children, hospitalization in children. But still, we know that children are less likely to get those severe complications.

HUANG: Now, before it happens, come up with a household plan. Is there a room and bathroom they can have for themselves? Lakdawala and her husband have two young kids, so their plan is to split into parent-child pairs. One would care for the sick kid, the other for the not sick. They'd stay in different parts of the house, take turns in the kitchen. But if space is tight, there are other things you can do. Everyone should wear masks except when eating or sleeping - open windows, run some fans, use an air filter - because remember, the coronavirus travels through the air. And after a few days, test to see if anyone else is sick. And if you think you might need backup, come up with a list of family, friends, neighbors that are fully vaccinated so they might be able to step in and help.

CORNISH: What's the timeline on that, though? I mean, how long, you know, would a parent or guardian be having to do that?

HUANG: Well, people with COVID-19 are most likely to spread the infection to others when their symptoms first appear. So 10 days later, if those symptoms are completely gone and they're not taking medicine to alleviate fever anymore, the illness is no longer considered contagious. Scientists know less about how easy it is for people who test positive but have no symptoms to spread the virus. And the recommended quarantine period for people who are asymptomatic if they're unvaccinated is 10 days after they first test positive.

CORNISH: All right. Another scenario - what if a student tests positive - right? - in a child's class? So your child isn't sick, but maybe they've been in close contact. I mean, would a household need to quarantine then?

HUANG: So the CDC definition of a close contact at school is actually pretty limited. If your kid was at least 3 feet away from someone who tests positive and they were both fully masked, your kid is not exposed. But if one of them wasn't masked, then your child would probably need to quarantine, assuming that they're not vaccinated. That doesn't mean that they have to go to their room and stay there. The experts that I talked with said, be reasonable, keep some distance, especially from vulnerable or unvaccinated people. But if the rest of the family remains healthy, one expert said that she would feel comfortable sending everyone to school and work and the grocery store with masks. But she would cancel non-essential business like playdates and dinners out.

CORNISH: It's funny. We're at this point in the pandemic where it feels like each of us is relying on the decisions that other people make.

HUANG: Yeah, absolutely. That's something that I heard from the experts that I spoke with as well. We know that vaccines do reduce transmission a lot, but they're not perfect. And we're hearing about breakthrough infections right now. So it is going to be possible in school settings for even vaccinated adults - you know, teachers, bus drivers, cafeteria staff - to infect children and for children to transmit the virus to others. And that's why masks are an important tool right now.

You know, if you're thinking about what kind of mask, the experts I spoke with said the best one is something that your child will wear consistently and correctly. You know, some of them had cute ones with cat faces or smiley faces. You can also get one of those cloth ones with a space to insert a little filter. You can even double mask. But the bottom line with kids is comfort. So if a tight or a thick mask is going to prevent a child from wearing it consistently, just go with what's most comfortable.

CORNISH: That's NPR's Pien Huang. Pien, thanks so much for explaining all this.

HUANG: Thanks for having me.

CORNISH: And Pien and our colleagues at NPR's Science Desk, they have answers to even more questions about how to keep kids safe from the delta variant. And you can find a link to all that in our episode notes. It's CONSIDER THIS FROM NPR. I'm Audie Cornish.

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